Provider First Line Business Practice Location Address:
32 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29150-5245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-773-8447
Provider Business Practice Location Address Fax Number:
803-775-0751
Provider Enumeration Date:
04/12/2006